_ teng_ resWcgo_ 1. TITLE OF RESEARCH TRAINING PROPOSAL (Do not Minority Predoctoral Fellowship Program 2. LEVEL OF FELLOVVSHIP Predoctoral 4a. NAME OF APPLICANT (Last, First, Middle Ini#aO Borja, David 4d. PRESENT MAILING ADDRESS (St._, Cily, State, Zip 9250 NW 26 Place Sunrise FL, 33322 Meeting Dates Date Received ind4cate. exceed 56 characters, including spaces and punotuation.) (F31) 3. PROGRAM ANNOUNCEMENT/REQUEST FOR APPLICATIONS PA-00-069 41). EMAIL ADDRESS 4c. HIGHEST DEGREE(S) dborja@med.miami.edu BS, , Code) 4e. PERMANENT MAILING ADDRESS (Street, C/_, State, Zip Code) 9250 NW 26 Place Sunrise FL, 33322 4f. OFFICE TELEPHONE NO. 4g. HOME TELEPHONE NO. 411. PERMANENT PHONE NO. 4i. FAX NUMBER (Area Code, No. and ExQ (Area Code and No.) (Area Code end No.) (Am Code and No.) 305-326-6044 954-746-5067 4j. [] U.S. CITIZEN OR U,S. NONCITIZEN NATIONAL or [] 5. TRAINING UNDER PROPO6ED AWARD (See Fields of Training) !Discipline No.: Subcatagory Name: 1200 Biomedical Engineering 7a. DATES OF PROPOSED AWARD 7B. PROPOSED AWARD DURATION 48 954-746-5067 305-326-6139 PERMANENT RESIDENT OF U.S. 6. PRIOR AND/OR CURRENT NRSA SUPPORT (Individual or I_aO [] NO [] YES (If=Yes_"rofartoitem24, FcwnPegeS) 8. DEGREE SOUGHT DURING PROPOSED AWARD 9. HUMAN 9a. RESEARCH EXEMPT 9b. HUMAN SUBJECTS 9c. ASSURANCE NO. SUBJECTS [] NO [] YES [] NO if'Yes" Exemption No,: [] YES [] 11a. NAME OF SPONSOR (Last, first, middle initial) Manns, Fabdce Telephon(e3"05) 284-2335 FAX: (305) 284-6494 Email: fmanns@miami.edu 11c.DEPARTMENSTE, RVICEL, ABORATOROYR, EQUIVALENT Biomedical Engineering 11d. MAJOR SUBDIVISION College of Engineering 13. NAME AND TEL. NO. OF ADVISOR IF DIFFERENT FROM 1la. Co-sponsor: Parel, Jean-Marie Telephon(e3:05) 326-6369 Name and address of institution where research training will take place if different from Item 11 b. Same Address: NIH-DEFINED PHASE III lOa. VERTEBRATE ANIMALS 10b. ANIMAL WELFARE CLINICAL TRIAL ASSURANCE NO. []NO NO [] YES [] YES 1 lb. NAME OF PROPOSED SPONSORING INSTITUTION University of Miami A_ress: Dept. of Biomedical Engineering P.O. Box 248294 Coral Gables, FL 33124-0621 12. ENTITY IDENTIFICATION NO. DUNS NO. (if available) 14. NAME OF OFFICIAL IN BUSINESS OFFICE Sandy Blanco Telephone: 305-284-4541 FAX: 305-284-2032 rme: Assist. Director AddressO:fficeof Research Admin. Rhodes House, Bldg. 37A P.O. Box 248293 Coral Gables, FL 33124-5215 Emell: sblanco@miami.edu 15. APPLICANT CERTIFICATION AND ACCEPTANCE: I certify that the statements herein are true, complete, and accurate to the best of my knowledge, and I agree to comply with the terms and conditions of award if an award is issued as a result of this application. I am aware that any false, fictitious, or fraudulent statements or dairns may subject me to criminal, civil, or administrative penalties. I codify that I have read the Ruth L. Kimchsteln National Research Service Award Assurance, that I will abide by the Assurance if an award is made, and that the award will not support residency training. SIG NATU RE (R(_ _/cent__._r;t) DATE M_cent I ;p _O._